Validity and Reliability of the Self-administered Psycho-TherApy-SystemS (SELFPASS) Item Pool for the Daily Mood Tracking of Depressive Symptoms: Cross-sectional Web-Based Survey

Backgrounde-Mental health apps targeting depression have gained increased attention in mental health care. Daily self-assessment is an essential part of e-mental health apps. The Self-administered Psycho-TherApy-SystemS (SELFPASS) app is a self-management app to manage depressive and comorbid anxiety symptoms of patients with a depression diagnosis. A self-developed item pool with 40 depression items and 12 anxiety items is included to provide symptom-specific suggestions for interventions. However, the psychometric properties of the item pool have not yet been evaluated. ObjectiveThe aim of this study is to investigate the validity and reliability of the SELFPASS item pool. MethodsA weblink with the SELFPASS item pool and validated mood assessment scales was distributed to healthy subjects and patients who had received a diagnosis of a depressive disorder within the last year. Two scores were derived from the SELFPASS item pool: SELFPASS depression (SP-D) and SELFPASS anxiety (SP-A). Reliability was examined using Cronbach α. Construct validity was assessed through Pearson correlations with the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder Scale-7 (GAD-7), and the WHO-5-Wellbeing-Scale (WHO-5). Logistic regression analysis was performed as an indicator for concurrent criterion validity of SP-D and SP-A. Factor analysis was performed to provide information about the underlying factor structure of the item pool. Item-scale correlations were calculated in order to determine item quality. ResultsA total of 284 participants were included, with 192 (67.6%) healthy subjects and 92 (32.4%) patients. Cronbach α was set to .94 for SP-D and α=.88 for SP-A. We found significant positive correlations between SP-D and PHQ-9 scores (r=0.87; P<.001) and between SP-A and GAD-7 scores (r=0.80; P<.001), and negative correlations between SP-D and WHO-5 scores (r=–0.80; P<.001) and between SP-A and WHO-5 scores (r=–0.69; P<.001). Increasing scores of SP-D and SP-A led to increased odds of belonging to the patient group (SP-D: odds ratio 1.03, 95% CI 1.01-1.05; P<.001; SP-A: 1.05, 1.05-1.01; P=.01). The item pool yielded 2 factors: one that consisted of mood-related items and another with somatic-related items. ConclusionsThe SELFPASS item pool showed good psychometric properties in terms of reliability, construct, and criterion validity. The item pool is an appropriate source for daily mood tracking in future e-mental health apps among patients with depression. Our study provides general recommendations for future developments as well as recommendations within the item pool

Prognostic relevance of elevated pulmonary arterial pressure assessed non-invasively: Analysis in a large patient cohort with invasive measurements in near temporal proximity.

The clinical relevance of non-invasively derived pulmonary arterial pressure (PAP) by Doppler echocardiography (DE) has been questioned in the past. However, transthoracic echocardiography is used as a cornerstone examination for patients with dyspnea and suspected pulmonary hypertension (PH). This study aimed to evaluate the prognostic value of non-invasive assessed PAP in a large population of patients with known or suspected cardiopulmonary disease.The analyses are based on data of patients of a tertiary cardiology center that received right heart catheterization (RHC) as well as non-invasively assessed PAP by DE within five days, and includes serological and clinical parameters in a retrospective follow-up for up to eight years.Of 1,237 patients, clinical follow-up was possible in 1,038 patients who were included in the statistical analysis. The mean-follow up time was 1,002 days. The composite endpoint of heart transplantation (HTx) or death occurred in n = 308 patients. Elevated PAP measured non-invasively as well as invasively had significant prognostic impact (hazard ratio (HR) 2.32; 95% confidence interval (CI) 1.78-3.04; χ2 = 37.9; p<0.001 versus HR 2.84; 95%CI 2.11-3.82; χ2 = 51.9; p<0.001, respectively). By multivariate analysis, NYHA functional class, N-terminal pro-brain natriuretic peptide, cardiac troponin T, left ventricular ejection fraction, and right ventricular dysfunction remained independently predictive. Incremental prognostic information in a multimodal approach was highly relevant.In this comprehensive study, elevated pulmonary arterial pressure measured by DE offers similar prognostic information on survival or need for HTx as right heart catheterization. Furthermore, the addition of functional capacity and serological biomarkers delivered incremental prognostic information

Univariate survival analysis by Cox proportional regression.

<p>Univariate survival analysis by Cox proportional regression.</p

Incremental predictive information for survival of multimodal clinical settings based on complete-case data (n = 395).

<p><b>Abbreviations:</b> Clin: clinical assessment (age, sex, NYHA functional class), Clin+Echo: clinical assessment and transthoracic (Doppler) echocardiography (LV-EF, RV dysfunction, sPAP, RAP), Clin+Sero: clinical assessment and cardiac serological parameters (NT-proBNP, cTnT); Clin+Sero+Echo: clinical assessment, cardiac serological parameters and transthoracic echocardiography combined; Clin+Sero+Echo+RHC: Non-invasive diagnostics and RHC (CI, mPAP, RAP) combined; Clin+RHC: clinical assessment and RHC (CI, mPAP, RAP) combined. <b>**</b>p<0.001. NYHA New York Heart Association, LV-EF left ventricular ejection fraction, sPAP systolic pulmonary arterial pressure, RAP right atrial pressure, NT-proBNP N-terminal pro brain natriuretic peptide, cTnT cardiac troponin T, CI cardiac index, mPAP mean pulmonary arterial pressure, RHC right heart catheterization.</p

Prognostic relevance of elevated pulmonary arterial pressure assessed non-invasively: Analysis in a large patient cohort with invasive measurements in near temporal proximity - Fig 4

<p><b>Outcome differentiated by PAP for subgroup of patients:</b> left ventricular cardiomyopathy (CMP):A,B; valvular heart disease: C,D; ischemic heart disease (IHD): E,F and rare cardiac diseases: G;H. Invasive measurements by RHC (A,C,E,G) are compared to non-invasively assessment by DE (B,D,F,G). <b>Abbreviations:</b> m/sPAP mean/systolic pulmonary arterial pressure, HR hazard ratio, 95%CI 95% confidence interval, ns not significant.</p